MedicalResearch.com Interview with:
Sally H. Adams, PhD, RN
Specialist, Division of Adolescent and Young Adult Medicine
Adolescent and Young Adult Health National Resource Center
University of California, San Francisco
Benioff Children’s Hospital
San Francisco, CA 94118
MedicalResearch.com: What is the background for this study?
Response: Major causes of adolescent illness and mortality are preventable. To address this, in the 1990s, professional medical organizations developed healthcare provider guidelines for the delivery of adolescent preventive healthcare. These include the receipt of anticipatory guidance and risk screening services in the effort to promote healthy behaviors and avoid risky behaviors that are intended to be covered within a preventive care visit, but could be addressed in other healthcare visits.
The adolescent developmental period is an important time for adolescents to be engaged with the healthcare system. Transitioning from childhood to adulthood, adolescents are becoming increasingly independent – having more responsibility and freedom for decision making in many areas, including healthy choices in behaviors and activities. While families and community settings (schools, churches) play strong roles in this process, the healthcare system also plays an important role.
Adolescents’ preventive healthcare should include a role for parent involvement as well as a time for adolescents to develop a more independent relationship with their provider. A preventive visit, focused on health promotion and risk prevention has several functions. First, it provides the framework for gaining experience in accessing the healthcare system. Second, the healthcare provider has the opportunity to discuss behaviors that are important for present and future health, to give positive reinforcement for healthy behaviors, and voice concern about behaviors that place adolescents at risk. Health topics usually include safety, obesity prevention, substance use, and sexual health. Third, having some time to meet alone with a provider increases the adolescent’s independence and provides opportunities to speak privately about health concerns. There is research evidence showing that provider messages to adolescents have a significant influence on reducing risky behaviors in many areas. Fourth, other important preventive services that should be covered for adolescents include depression screening and monitoring of immunization status.
Despite the benefits and value of adolescent preventive care visits and preventive services, rates of preventive care for adolescents have remained low. This is concerning because high percentages of adolescents are experiencing serious preventable health problems that impact health now and likely in the future. These include high rates of obesity (30%), diagnosable mental illnesses (20%), and high rates of substance use and abuse (tobacco, alcohol, and illicit and prescription medications, including opioids; rates vary).
MedicalResearch.com: What are the main findings?
1) Our study, comparing preventive care rates from the pre- to post- Affordable Care Act (ACA) implementation, found moderate increases in several preventive services for adolescents, including rates of attending a preventive care visit (7% increase). The greatest increases in preventive visit rates were among minority and low-income adolescents and this is likely because of increases in the percentage of adolescents who had full-year public health insurance. While this is encouraging, still, fewer than half of all adolescents had a preventive visit in the past year and that includes those who were insured for the full year. This indicates that insurance is important but that other factors, likely involving family and community awareness of the importance of the preventive visit, play important roles as well.
2) Many of the individual preventive services increased from pre- to post- ACA, indicating that providers have changed their practices by increasing emphasis on prevention. Still, the overall rates remain far below recommended levels.
3) We found little or no increase in the percentage of adolescents who had time alone with a provider at their most recent healthcare visit, indicating that at most, only 1 in 3 had the opportunity for a private discussion with a provider.
MedicalResearch.com: What should clinicians and patients take away from your report?
1) Most adolescents are not receiving important preventive services. Families need to know that receiving preventive services can be highly important in their adolescents’ present and future health, and that these services are available for most families at no cost.
2) Preventive care visits are a dedicated time for the receipt of preventive services; however any healthcare visit is an opportunity for providers to deliver preventive services.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
1) Research of effective ways to increase families’ awareness of the value/importance of the adolescent preventive care visit and individual preventive services are very important in the effort to increase the provision of care to adolescents.
2) The field needs more focused research to improve the healthcare system’s capacity to provide preventive services in a confidential setting.
MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.
Adams SH, Park MJ, Twietmeyer L, Brindis CD, Irwin CE. Association Between Adolescent Preventive Care and the Role of the Affordable Care Act. JAMA Pediatr. Published online November 06, 2017. doi:10.1001/jamapediatrics.2017.3140
Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.